PB2351: ANXIETY AT THE HEMATOLOGIST
Authors: S. Trojan, A. Garma, V. Gveric-Krecak, I. Krecak
Journal: HemaSphere (2022)

Background: Referral to outpatient hematology clinics may increase the stress and anxiety for the patients, as they may perceive that they are being referred for evaluation of a cancer diagnosis. Aims: To investigate the severity of anxiety in subjects referred to a hematologist for the first time. Methods: This prospective single-center study measured the severity of anxiety in an unselected cohort of subjects referred to a hematologist for the first time using a internationally validated anxiety-focused questionnaire, Generalized Anxiety Disorder-7 (GAD-7). Excluded from participation were subjects younger than <18 years of age and those who were already known to have anxiety disorders, depression, or schizophrenia. The GAD-7 questionnaire is widely used to rapidly screen for anxiety and to measure its severity across different anxiety disorders, as well as in the general population. It evaluates the 7 core anxiety symptoms on a 4-point scale (0-3) with a maximum score of 21. Seven measured symptoms are as follows; (1) feeling nervous, anxious, or on edge; (2) being able to stop or control worrying; (3) worrying too much about different things; (4) trouble relaxing; (5) being restless; (6) becoming easily annoyed or irritable; and (7) feeling afraid as if something awful might happen. Response options are “not at all”, “several days”, “more than half the days”, and “nearly every day”, scored as 0, 1, 2, and 3, respectively. Higher scores reflect greater anxiety severity, and the scores of 5, 10, and 15 represent mild, moderate, and severe anxiety symptom levels, respectively. The cut-off point of ≥10 identifies probable cases of GAD that may require further psychiatric assessment. Results: A total of 203 subjects were invited to participate in the study, 163 (80.3%) responded and were included in this analysis. The median age was 60 years (range 19-89) and 96 (59%) were female. Median GAD-7 score of all subjects was 5 (range 0-21), with 81 (49.7%), 44 (27%), 31 (19%) and 7 (4.3%) of subjects having no, mild, moderate and severe anxiety symptoms, respectively (Figure 1). Therefore, a total of 82 subjects (50.3%) showed signs of anxiety and 38 patients (23.3%) had GAD-7 score of ≥10, which may even suggest possible cases of GAD. Females had higher GAD-7 scores (median 5, range 0-21) when compared to males (median 3, range 0-20, p=0.008), whereas the GAD-7 score did not correlate with age (rho=0.041, p=0.600). Notably, there was no difference in GAD-7 scores between patients with malignant (15.3%) or benign (84.7%) hematological disorders (p=0.320) Image:Summary/Conclusion: Even though the vast majority of referred patients in this study had benign hematological disorders (84.7%), half of them showed signs of anxiety. Furthermore, approximately one-fourth of subjects showed moderate or severe signs of anxiety and may, therefore, even be considered as having possible GAD; this incidence of possible cases of GAD is well above that from the general population (~5%). Limitations of the study are single-center design, outpatient selection bias, and the lack of evaluation of other medical (i.e., laboratory assays) and non-medical risk factors (i.e., educational level, employment status, marrital status, or income) on the degree of anxiety. Nevertheless, these results show that referrals to hematologists may have a negative impact on the psychological state of a patient. Therefore, future studies should focus on the strategies which may help to alleviate these negative emotions.